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The unkindest cut: Self-harm about relief, not suicide

Cutting is the most common form of self-harm or “nonsuicidal self-injury,” a clinically recognized condition that Mental Health America estimates affects 2 million Americans, mostly teens and young adults. JIM REED/STAFF PHOTO ILLUSTRATION

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English actor Russell Brand and former Disney TV star Demi Lovato are among the celebrities who publicly shared their struggles with cutting, a self-harm behavior affecting about 15 percent of the population.***Where to get help

It's hard to imagine repeatedly cutting, burning, beating or scratching a body can make someone feel better. But people who self-harm are trying to cope emotionally, using this dangerous behavior.There are some common myths about the condition that affects millions of Americans, many of them teens and young adults, says Nancy Gordon, a licensed clinical social worker and founder of the Tampa Bay Center for Cognitive Behavior Therapy.Misconceptions include:1.You can stop self injury on your own. People who repeatedly self injure are conditioned to think the actions make them feel better. New coping skills must be taught and reinforced.2.Self harm doesn't hurt anyone else. Friends and family are affected by the behavior of a person who cuts or burns or beats their body.3.Cutters are trying to kill themselves. Extreme self harm can lead to accidental death, but most who do it are purposely not trying to seriously injure themselves. Many are prepared to bandage and clean up immediately.4.Self harm has nothing to do with other psychological conditions. Almost always, a person who repeatedly self harms is dealing with additional conditions, such as borderline personality disorder.5.There's no help out there. Because self harm is connected to other conditions, it's hard to find counselors who officially list it as a concentration of their practice. However, there are many counselors trained at helping individuals learn new coping skills and address emotional problems. Ask.Learn more about self injury, borderline personality disorders and treatment:Crisis Center of Tampa Bay: www.crisiscenter.com or call 211 (24-hour hotline)S.A.F.E. (Self Abuse Finally Ends) Alternatives, a self abuse treatment program and resource: http://www.selfinjury.com/ or (800) DON'T-CUT (information line)Florida Borderline Personality Disorder Association, Tampa-area based: http://www.fbpda.org/National Education Alliance Borderline Personality Disorder: http://www.borderlinepersonalitydisorder.com/Treatment and Research Advancements Association for Personality Disorder: http://www.tara4bpd.orgHealthy Place, a consumer mental health site: www.healthyplace.comTribune staff

She connects the first cuts to 9/11.

Steph was 14, and the terrorist attacks in New York had rattled an already shaky reality of steady moves, few friends and a family insistent that she maintain a cool, not-too-emotional front.

The shy teen suppressed her frantic fear for a few months. Then an old episode of TV's classic moralistic drama “7th Heaven” popped into her head: the one where “Lucy's friend was cutting and they send her away,” she said.

Steph grabbed the first thing she could find — that day it was kitchen scissors. She went to her room, sat down and slit the skin on her left ankle until it bled.

She didn't know what to expect, but that rush of seeing blood — her own blood seeping through the surface of the skin she cut — pushed aside the chaos inside her head. No one knew about it. And Steph felt calm.

“It worked as a distraction for me. … It turned that more emotional pain into something tangible,” she said. “For me, it's something that brings me back to reality and back to the here and now.”

Now 26, Steph wishes she had never picked up those kitchen scissors. That desperate adolescent experiment to feel better morphed into a dangerous, compulsive behavior she still struggles to control a dozen years later. Her most recent lapse: a reaction to the tragic bombings at the Boston Marathon.

“It's a comfort in a twisted way. It really is,” she said of the irrational thoughts that over time have led to thin, clean scars on her legs and both forearms. “And it's really hard to stop.”

Cutting is the most common form of self-harm or “nonsuicidal self-injury,” a clinically recognized condition that Mental Health America estimates affects 2 million Americans, mostly teens and young adults. Those who intentionally and repeatedly cut or burn or beat themselves aren't trying to die; they want to release irrational, intense emotions they think they aren't equipped to handle any other way.

Most people equate the condition to teen girls or young women. In most cases, though, it's associated with other conditions, such as borderline personality disorder.

The new American Psychiatric Association diagnostic manual, which is being released this month, formally identifies nonsuicidal self-injury for the first time.

But counselors say self-harm also is becoming more mainstream, an emotional escape akin to drinking alcohol or experimenting with drugs.

“We don't just see it with people who have borderline personality disorders,” said Ann Jaronski, counseling center director at the University of South Florida. “We do see self-harm in normal students, students with anxiety and students with depression.”

Google the term cutting and thousands of online images and videos appear. Graphic, bloody examples are listed along with cynical parodies, “how-tos” for covering up scars, confessional celebrity interviews, even an online “self-cutting generator” that lets you type in phrases that you want “cut” into a disembodied forearm.

It's so widely known that when images of pop star Justin Bieber allegedly smoking pot hit the Internet in January, online pranksters suggested fans cut themselves in protest. The #CutforBieber hysteria outraged his devoted legions around the world.

Nick, a married father of two young boys, is horrified at the idea people would cut as a joke or as a way to try to outdo someone else's extreme behavior. He knows that people who self-harm would rather mask this risky and unhealthy coping behavior.

After all, he hid it more than 15 years.

“Some people drink, some people do drugs. Some people bite their nails,” said Nick, 32. “And this is one way I cope with things I have no control over. With a razor blade.”

Until a few months ago, the graphic artist's parents, his sister, even his wife of nine years had no idea he sporadically cut his forearms when he felt overwhelmed and out of control. Nick entered therapy a year ago for what he and his wife thought was depression. A diagnosis and treatment for bipolar disorder eventually revealed his longtime use of cutting to regain emotional control.

“When I was younger, it was more like a high,” he said of the cutting he once did as often as a few times a week at home or at work. When he worked at a craft store, box cutters were always in the stockroom. Now, the X-Acto knives he uses for his artwork come in handy to make the small cuts Nick immediately covers up with a bandage.

“When you see the blood coming out of you, it's very much like an exciting effect,” he said. “But then you get ashamed, and you want to try and hide it, cover it.”

Hiding a disorder like this isn't as hard as it might seem. Steph blamed the family cat, Max, or a metal locker at her high school for the marks. Nick would say his scrapes came from the enormous box staples at work or, better, the thorny bushes he tangled with doing yard work. Long sleeves — worn even during the most blistering Florida summer days — are great camouflage.

It also helps that on the surface, most people who self-harm appear incredibly average. Steph has worked at a coffee shop for six years and attends Hillsborough Community College full time. She and her partner have been together six years.

Nick has been at the same job for eight years.

“Most of us cut because we don't want to die,” said Nick, who wears an orange bracelet that urges “Hope. Courage. Faith.” “We want to deal with life without having to give up.”

Steph was 17, living with her family in Fort Myers and cutting up to 10 times a day when she first tried to stop. Afraid to ask her parents for help, she scanned the local Barnes & Noble bookstore until she found “Bodily Harm,” ($16.99, Hyperion) a book from St. Louis' SAFE Alternatives treatment program.

It was the first time Steph could name what she did. Although the book's questionnaire about self-injury convinced her professional therapy was needed, she was too ashamed.

When Steph got help in 2011, she also was battling an addiction to alcohol and prescription drugs. She's been sober — and self-harm free — for stretches as long as nine months.

“It's been harder for me to remain clean from self-injury than it has from alcohol because I've done it so long,” she said. To this day, she carries a sharpened plastic gift card in her pocket or wallet “in case” she wants to cut.

Self-harm for people like Steph becomes an ineffective “go-to” coping mechanism in times of stress, said Nancy Gordon, founder of the Tampa Bay Center for Cognitive Behavior Therapy in Brandon. But just like anorexics who can't be “cured” by eating, stopping isn't as simple as putting down the kitchen scissors.

“You are asking them to change ingrained behaviors where they feel relief,” said Gordon, whose therapies redirect patients to use new coping tools.

Steph and others who cut say they were terrified how family and friends would react to their behavior.

“Definitely talk to someone who you trust, because some people will freak out about it and have the wrong reaction,” Steph said. “And that will just mess you up.”

Gordon said it's critical that parents with a teen in this situation try their best to avoid judgment and criticism. Your response has to be gentle despite fears your child is going to be hurt or killed.

“It's hard. Because you are scared,” Gordon said.

Nick told his wife, Tiffany, about his cutting weeks after the birth of the couple's second son. His work in therapy had rekindled his suppressed urges to cut and a co-worker noticed some fresh slits on his arm. He went home from work, knowing it was time to talk.

Tiffany said she wasn't angry.

“It was kind of a helpless feeling. You don't know how to help,” she said. “And also, I want to handle things more and not put so much on him.”

Initially, she said, she couldn't help but worry or check his forearms for marks.

“I worried every time he went outside. 'What is he doing? Is he doing it now? Should I go check on him?'” she said. “He's been doing well for a little while, so I haven't been looking. I haven't felt like I needed to check on him. I try not to, because I don't want to be overbearing or make him feel self-conscious.”

Nick, who uses journaling as a new coping tool, has since told his parents and sister about the cutting he thought was a behavior unique to him. Sharing with family is a mixed blessing that ultimately reinforces his recovery, he said.

“It's weird but nice, because you don't have to hide. But at the same time you have a bandage on your arm and they know that you do this,” Nick said. “They probably want to talk about it. I don't.”

Public awareness about cutting and self-harm is good, but there are consequences to its high-profile presence in pop culture, said Misty Fenton, a licensed mental health counselor in Tampa. Although some kids never give it a second thought, others who struggle with “tremendously adult problems” such as sexual abuse are more likely to use it as an escape, Fenton said.

“They don't know how to handle (complex emotional problems). Kids, they don't have that ability,” Fenton said. “So they notice when a friend says, 'I cut, and it makes me feel better.'”

People who self-harm usually don't want to be noticed, so cuts may be small and clean, counselors say. But there are clues, like a hidden first-aid kit or bandages, sewing needles or mangled paper clips. More importantly, there's likely a change in mood or the need to wear long-sleeve shirts or long pants all the time, Fenton said.

“Sometimes as parents, you have to say that you want to see their arms and legs,” she said.

Treatment in most cases involves helping people understand that their desire to self-harm is unhealthy. Alternatives — journaling, logging irrational thoughts in a diary, going for a walk — are encouraged, Gordon said. However, treatment for the intense emotions often triggers more self-harm before a person starts to feel better.

At USF, students can receive a free counseling consultation and services, Jaronski said. There is also a “students of concern” committee that friends, roommates or even professors can see to express concerns about a student who might need help.

“People can get help. … There are things that can be done,” she said.

Steph, who relies on weekly therapy and 12-step meetings, knows the result of not getting help soon enough. She sees the YouTube videos and nonchalant references to cutting on TV and worries.

“I wish I never started. And when I see other people (who cut) it makes me really sad for them. I think it's terrible,” she said. “It's sad.”

The release and relief that come from cutting aren't worth it, Nick and Steph said.

The physical and emotional scars can heal, if you really want it.

“It was just something that was in my life that I didn't fully understand,” Nick said. “I want people that do this — I want them to understand they are not alone. There is another side,” he said. “There is help out there. Take it.”